Gentamicin for treatment of gonococcal urethritis in Malawi

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Costs and Consequences of Traffic Fines and Fees: A Case Study of Open Warrants in Las Vegas, Nevada

Traffic stops and tickets often have far-reaching consequences for poor and marginalized communities, yet resulting fines and fees increasingly fund local court systems. This paper critically explores who bears the brunt of traffic fines and fees in Nevada, historically one of the fastest growing and increasingly diverse states in the nation, and one of thirteen US states to prosecute minor traffic violations as criminal misdemeanors rather than civil infractions. Drawing on legislative histories, we find that state legislators in Nevada increased fines and fees to raise revenues. Using descriptive statistics to analyze the 2012–2020 open arrest warrants extracted from the Las Vegas Municipal Court, we find that 58.6% of all open warrants are from failure to pay tickets owing to administrative-related offenses—vehicle registration and maintenance, no license or plates, or no insurance. Those issued warrants for failure to pay are disproportionately for people who are Black and from the poorest areas in the region. Ultimately, the Nevada system of monetary traffic sanctions criminalizes poverty and reinforces racial disparities

Early detection of malaria foci for targeted interventions in endemic southern Zambia

<p>Abstract</p> <p>Background</p> <p>Zambia has achieved significant reductions in the burden of malaria through a strategy of "scaling-up" effective interventions. Progress toward ultimate malaria elimination will require sustained prevention coverage and further interruption of transmission through active strategies to identify and treat asymptomatic malaria reservoirs. A surveillance system in Zambia's Southern Province has begun to implement such an approach. An early detection system could be an additional tool to identify foci of elevated incidence for targeted intervention.</p> <p>Methods</p> <p>Based on surveillance data collected weekly from 13 rural health centres (RHCs) divided into three transmission zones, early warning thresholds were created following a technique successfully implemented in Thailand. Alert levels were graphed for all 52 weeks of a year using the mean and 95% confidence interval upper limit of a Poisson distribution of the weekly diagnosed malaria cases for every available week of historic data (beginning in Aug, 2008) at each of the sites within a zone. Annually adjusted population estimates for the RHC catchment areas served as person-time of weekly exposure. The zonal threshold levels were validated against the incidence data from each of the 13 respective RHCs.</p> <p>Results</p> <p>Graphed threshold levels for the three zones generally conformed to observed seasonal incidence patterns. Comparing thresholds with historic weekly incidence values, the overall percentage of aberrant weeks ranged from 1.7% in Mbabala to 36.1% in Kamwanu. For most RHCs, the percentage of weeks above threshold was greater during the high transmission season and during the 2009 year compared to 2010. 39% of weeks breaching alert levels were part of a series of three or more consecutive aberrant weeks.</p> <p>Conclusions</p> <p>The inconsistent sensitivity of the zonal threshold levels impugns the reliability of the alert system. With more years of surveillance data available, individual thresholds for each RHC could be calculated and compared to the technique outlined here. Until then, "aberrant" weeks during low transmission seasons, and during high transmission seasons at sites where the threshold level is less sensitive, could feasibly be followed up for household screening. Communities with disproportionate numbers of aberrant weeks could be reviewed for defaults in the scaling-up intervention coverage.</p

Malaria Research Challenges in Low Prevalence Settings

The prevalence of malaria has reduced significantly in some areas over the past decade. These reductions have made local elimination possible and the research agenda has shifted to this new priority. However, there are critical issues that arise when studying malaria in low transmission settings, particularly identifying asymptomatic infections, accurate detection of individuals with microparasitaemic infections, and achieving a sufficient sample size to have an adequately powered study. These challenges could adversely impact the study of malaria elimination if they remain unanswered

Malaria Research Challenges in Low Prevalence Settings

The prevalence of malaria has reduced significantly in some areas over the past decade. These reductions have made local elimination possible and the research agenda has shifted to this new priority. However, there are critical issues that arise when studying malaria in low transmission settings, particularly identifying asymptomatic infections, accurate detection of individuals with microparasitaemic infections, and achieving a sufficient sample size to have an adequately powered study. These challenges could adversely impact the study of malaria elimination if they remain unanswered

Maximizing HIV partner notification opportunities for index patients and their sexual partners in Malawi

Introduction: HIV testing and counselling (HTC) is important to effect positive sexual behaviour change and is an entry point to treatment, care, and psychosocial support. One of the most practical initiatives to increase HTC is to encourage sexual partners of HIV-infected persons to test for HIV. However, partner notification strategies must be feasible in the healthcare setting and acceptable to the population. Methods: We conducted a qualitative study during the pilot phase of an HIV partner notification trial to complement its assessment of feasibility and acceptability of methods of partner notification. We performed in-depth interviews with 16 consecutive HIV-positive index participants who consented and their 12 identifiable sexual partners. We also conducted two focus group discussions with healthcare workers to supplement the patient perspectives. In the main study, newly diagnosed HIV cases (index cases) were randomized to one of three methods of partner notification: passive, contract, and provider referral. Clients in the passive referral group were responsible for notifying their sexual partners themselves. Individuals in the contract referral group were given seven days to notify their partners, after which a healthcare provider contacted partners who had not reported for counselling and testing. In the provider group, a healthcare provider notified partners directly. Results: Although most index participants and partners expressed a preference for passive notification, they also highlighted benefits for provider-assisted notification and the universal right for all HIV-exposed persons to know their HIV exposure and benefit from HIV testing and access antiretroviral treatment. Several participants mentioned couples counselling as a way to diffuse tension and get accurate information. All mentioned benefits to HIV testing, including the opportunity to change behaviour. Conclusions: Provider-assisted partner notification is not preferred, but it is acceptable and may complement the passive method of notification. Couples counselling should also be encouraged

Assessment of Peer-Based and Structural Strategies for Increasing Male Participation in an Antenatal Setting in Lilongwe, Malawi

In sub-Saharan Africa, although male involvement in antenatal care is associated with positive outcomes for HIV-infected women and their  infants, men rarely accompany female partners. We implemented a project to increase the number of male partners attending an antenatal clinic at Bwaila Hospital in Lilongwe, Malawi. We evaluated changes in the  proportion of women who came with a partner over three periods. During period 1 (January 2007 – June 2008) there was didactic peer education. During period 2 (July 2008 – September 2009) a peer-led   male-involvement drama was introduced into patient waiting areas. During period 3 (October 2009 – December 2009) changes to clinical infrastructure were introduced to make the clinic more male-friendly. The proportion of women attending ANC with a male partner increased from 0.7% to 5.7% to 10.7% over the three periods. Peer education through drama and  male-friendly hospital infrastructure coincided with substantially greater male participation, although further gains are necessary. Afr J Reprod Health 2014; 18[2]: 97-104).Keywords: HIV, antenatal, male involvement, HIV counseling and testing, disclosure, prevention of mother to child transmission, coupl

Changing individual-level risk factors for malaria with declining transmission in southern Zambia: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Malaria elimination will require that both symptomatic- and asymptomatic-infected persons be identified and treated. However, well-characterized, individual-level risk factors for malaria may not be valid in regions with declining malaria transmission. Changes in individual-level correlates of malaria infection were evaluated over three years in a region of declining malaria transmission in southern Zambia.</p> <p>Methods</p> <p>Malaria surveys were conducted in two study areas within the catchment area of Macha Hospital, Zambia in 2007 and 2008/2009. A random sample of households was identified from a digitized satellite image of the study areas. Cross-sectional surveys were conducted approximately five times throughout the year in each of the two study areas. During study visits, adults and caretakers of children were administered questionnaires and a blood sample was obtained for a rapid diagnostic test (RDT) for malaria.</p> <p>Results</p> <p>In the 2007 study area, 330 individuals were surveyed. 40.9% of participants lived in a household with at least one insecticide-treated bed net (ITN); however, only 45.2% reported sleeping under the ITN. 23.9% of participants were RDT positive. Correlates of RDT positivity included younger age, the presence of symptoms, testing during the rainy season, using an open water source, and not sleeping under an ITN. In the 2008 study area, 435 individuals were surveyed. 77.0% of participants lived in a household with at least one ITN; however, only 56.4% reported sleeping under the ITN. 8.1% of participants were RDT positive. RDT positivity was negatively correlated with the presence of symptoms within the last two weeks but positively correlated with documented fever. In 2009, 716 individuals were surveyed in the same area as 2008. 63.7% of participants lived in a household with at least one ITN; however, only 57.7% reported sleeping under the ITN. 1.5% of participants were RDT positive. Only self-reported fever was significantly correlated with RDT positivity.</p> <p>Conclusions</p> <p>With declining malaria prevalence, few individual-level characteristics were correlated with RDT positivity. This lack of correlation with individual characteristics hampers identification of individuals infected with malaria. Strategies based on ecological or environmental risk factors may be needed to target control efforts and achieve further reductions and elimination.</p

Farmer and researcher partnerships in Malawi: developing soil fertility technologies for the near-term and far-term

In Malawi, intensive production of maize (Zea mays) is pursued on over 60% of smallholder land, yet application of nutrients is almost nil. To improve adoption of soil productivity-enhancing technologies, two participatory methods were pursued: (i) a novel 'mother-and-baby' trial design and (ii) participatory action research with communities in a southern Malawi watershed. The central 'mother trial' was managed by researchers (replicated within a site) and systematically linked to farmer-managed 'baby' trials to cross-check biological performance with farmer assessment. The watershed approach involved a partnership of researchers and farmers addressing soil management. Technologies tested in both approaches integrated legumes into existing maize-based systems, sometimes in combination with inorganic fertilizers. Across methods, legume intensification increased yields by approximately 40% (net benefit increase of approximately US$50 ha-1) and fertilizer increased yields by approximately 70% compared with continuous maize grain yields of about 1100 kg ha-1. Farmer assessment prioritized technologies that included secondary benefits, such as weed suppression, grain legume yields, and low-labour-demanding fertilizer. A survey indicated that participating researchers and extension staff had reservations about the amount of time required to interact with farmers, and no clear consensus emerged regarding the best approach. There has been wider adoption of the mother-and-baby trial method by scientists in neighbouring countries, indicating the value of systematically incorporating farmers' input